Tuesday, March 27, 2012

Don't confuse cardiovascular imaging with preventive medicine

Despite the existence of well-established guidelines for clinicians on applying effective smoking cessation interventions in practice, one in five adults in the U.S. continues to smoke. This fact has led researchers to explore other ways to motivate smokers to quit, such as using imaging technology to show them the personal consequences of tobacco use. In a randomized trial recently published in the Archives of Internal Medicine, researchers tested the "pictures are worth a thousand words" theory by comparing cessation rates between smokers who received standard therapy plus carotid plaque ultrasonographic screening to smokers receiving standard therapy alone. The results were uniformly disappointing. Even though 58 percent of smokers in the intervention group were found to have carotid plaques, there was no statistical difference in cessation rates between the groups after one year, and patients with plaques were not more likely to quit smoking than those with normal ultrasound results.

In an accompanying editorial, Dr. Patrick O'Malley called for a renewed emphasis on developing communication skills throughout medical training:

We rely too much on technology and testing that are misapplied to problems that really should be addressed with cognitive, emotion handling, and relationship-centered skills. We need a paradigm shift in priorities and incentives to shift from excessive reliance on technologies, a terribly wasteful practice, to training and cultivation of communication- and relationship-based skills that are likely much more effective in the psychosocial domains of care.

Here are my two take-home points for physicians and patients:

1) To help smokers quit, talking trumps technology.
2) Don't confuse cardiovascular imaging with preventive medicine.


Part of the above post was originally published on the AFP Community Blog.


  1. Kenny, I didn't check who funded the trial, if it was an imaging device manufacturer. Both of your points are spot-on.

  2. Somewhat surprisingly, no industry funding was involved. Here's the financial disclosure statement: Funding/Support: This study was supported by research grant 3200B0-116097 from the Swiss National Science Foundation, by the Swiss Heart Foundation, by the Lausanne University Hospital Strategic Plan, and by grant FPT 08.002282 from the Swiss Tobacco Prevention Funds, Federal Office of Public Health.

  3. I love Dr. O'Malley's quote here.

    Dr. Kenny, what do you make of the recent report at ACC2012 that suggested heart patients who are shown their CT calcium scans are more motivated to take their statins and lose weight?

    More at: http://www.theheart.org/article/1374241.do